Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review
Restricted accessReview articleFirst published online January, 2021
Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review
In recent years there has been increasing attention for the prevalence and prevention of burnout among healthcare professionals. There is unclarity about prevalence of burnout in healthcare professionals providing palliative care and little is known about effective interventions in this area.
Aim:
To investigate the prevalence of (symptoms of) burnout in healthcare professionals providing palliative care and what interventions may reduce symptoms of burnout in this population.
Design:
A systematic literature review based on criteria of the PRISMA statement was performed on prevalence of burnout in healthcare professionals providing palliative care and interventions aimed at preventing burnout.
Data sources:
PubMed, PsycInfo and Cinahl were searched for studies published from 2008 to 2020. Quality of the studies was assessed using the method of Hawkers for systematically reviewing research.
Results:
In total 59 studies were included. Burnout among healthcare professionals providing palliative care ranged from 3% to 66%. No major differences in prevalence were found between nurses and physicians. Healthcare professionals providing palliative care in general settings experience more symptoms of burnout than those in specialised palliative care settings. Ten studies reported on the effects of interventions aimed at preventing burnout. Reduction of one or more symptoms of burnout after the intervention was reported in six studies which were aimed at learning meditation, improving communication skills, peer-coaching and art-therapy based supervision.
Conclusion:
The range of burnout among healthcare professionals providing palliative care varies widely. Interventions based on meditation, communication training, peer-coaching and art-therapy based supervision have positive effects but long-term outcomes are not known yet.
ShermanACEdwardsDSimontonS, et al. Caregiver stress and burnout in an oncology unit. Palliat Support Care2006; 4: 65–80.
2.
MaslachCJacksonSE.The measurement of experienced burnout. J Occupation Behav1981; 2: 99–113.
3.
MaslachCSchaufeliWBLeiterMP.Job burnout. Annu Rev Psychol2001; 52: 397–422.
4.
SchaufeliWLeiterMMaslachC.Burnout: 35 years of research and practice. Career Develop Intern2009; 14: 204–220.
5.
MaslachCLeiterMPSchaufeliWB.Measuring burnout. In CooperCLCartwrightS (eds). The Oxford handbook of organizational well-being. Oxford: Oxford University Press, 2008, pp. 86–108.
6.
ShanafeltTDHasanODyrbyeLN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general us working population between 2011 and 2014. Mayo Clin Proc2015; 90: 1600–1613.
7.
ZhangYYHanWLQinW, et al. Extent of compassion satisfaction, compassion fatigue and burnout in nursing: a meta-analysis. J Nurs Manag2018; 26: 810–819.
8.
HallLHJohnsonJWattI, et al. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One2016; 11: e0159015.
9.
PoghosyanLClarkeSPFinlaysonM, et al. Nurse burnout and quality of care: cross-national investigation in six countries. Res Nurs Health2010; 33: 288–298.
10.
Suñer-SolerRGrau-MartínAFlichtentreiD, et al. The consequences of burnout syndrome among healthcare professionals in Spain and Spanish speaking Latin American countries. Burn Res2014; 1(2): 82–89.
11.
SalvagioniDAJMelandaFNMesasAE, et al. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One2017; 12: e0185781.
12.
CampbellJDussaultGBuchanJ, et al. A universal truth: no health without a workforce. Forum Report, Third Global Forum on Human Resources for Health, Recife, Brazil. Geneva, Global Health Workforce Alliance and World Health Organization, 2013.
13.
HeWGoodkindDKowalP.An aging world: 2015. Washington, DC: U.S. Government Publishing Office, 2016.
WestCPDyrbyeLNErwinPJ, et al. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet (London, England)2016; 388: 2272–2281.
16.
PayneN.Occupational stressors and coping as determinants of burnout in female hospice nurses. J Adv Nurs2001; 33: 396–405.
17.
KearneyMKWeiningerRBVachonML, et al. Self-care of physicians caring for patients at the end of life: ‘Being connected. . . a key to my survival’. JAMA2009; 301: 1155–1164, E1151.
18.
DeanRA.Occupational stress in hospice care: causes and coping strategies. Am J Hosp Palliat Care1998; 15: 151–154.
IngebretsenLPSagbakkenM.Hospice nurses’ emotional challenges in their encounters with the dying. Int J Qual Stud Health Well-being2016; 11: 31170.
21.
DoughertyEPierceBMaC, et al. Factors associated with work stress and professional satisfaction in oncology staff. Am J Hosp Palliat Care2009; 26: 105–111.
22.
ParolaVCoelhoACardosoD, et al. Prevalence of burnout in health professionals working in palliative care: a systematic review. JBI Database System Rev Implement Rep2017; 15: 1905–1933.
23.
PereiraSMFonsecaAMCarvalhoAS.Burnout in palliative care: a systematic review. Nursing ethics2011; 18: 317–326.
24.
ParolaVCoelhoACardosoD, et al. Burnout in palliative care settings compared with other settings. a systematic review. J Hosp Palliat Nurs2017; 19: 442–451.
25.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6: e1000097.
26.
RietjensJABramerWMGeijtemanEC, et al. Development and validation of search filters to find articles on palliative care in bibliographic databases. Palliat Med2019; 33: 470–474.
27.
HawkerSPayneSKerrC, et al. Appraising the evidence: reviewing disparate data systematically. Qual Health Res2002; 12: 1284–1299.
28.
Al-MajidSCarlsonNKiyoharaM, et al. Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. J Nurs Adm2018; 48: 310–315.
29.
AndersonKAEwenHH.Death in the nursing home: an examination of grief and well-being in nursing assistants. Res Gerontol Nurs2011; 4: 87–94.
30.
ChamberlinPLambdenJKozlovE, et al. Clinicians’ perceptions of futile or potentially inappropriate care and associations with avoidant behaviors and burnout. J Palliat Med2019; 22: 1039–1045.
31.
ClaytonMFIacobEReblinM, et al. Hospice nurse identification of comfortable and difficult discussion topics: associations among self-perceived communication effectiveness, nursing stress, life events, and burnout. Patient Educ Couns2019; 102: 1793–1801.
32.
Dréano-HartzSRhondaliWLedouxM, et al. Burnout among physicians in palliative care: impact of clinical settings. Palliat Support Care2016; 14: 402–410.
33.
ErcolaniGVaraniSPeghettiB, et al. Burnout in home palliative care: what is the role of coping strategies?J Palliat Care2020; 35: 46–52.
34.
Fernández-SánchezJCPérez-MármolJMBlásquezA, et al. Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals. Palliat Support Care2018; 16: 286–297.
35.
FreyRRobinsonJWongC, et al. Burnout, compassion fatigue and psychological capital: findings from a survey of nurses delivering palliative care. Appl Nurs Res2018; 43: 1–9.
36.
GuoQZhengR.Assessing oncology nurses’ attitudes towards death and the prevalence of burnout: a cross-sectional study. Eur J Oncol Nurs2019; 42: 69–75.
37.
Hernandez-MarreroPPereiraSMCarvalhoAS.Ethical decisions in palliative care: interprofessional relations as a burnout protective factor? Results from a mixed-methods multicenter study in Portugal. Am J Hosp Palliat Care2016; 33: 723–732.
38.
KamalAHBullJHWolfSP, et al. Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. J Pain Symptom Manage2020; 59: e6–e13.
39.
KohMYChongPHNeoPS, et al. Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: a multi-centre cross-sectional study. Palliat Med2015; 29: 633–642.
40.
LobbEOldhamLVojkovicS, et al. Frontline grief: the workplace support needs of community palliative care nurses after the death of a patient. J Hosp Palliat Nurs2010; 12: 225–235.
41.
MaSHuangYYangY, et al. Prevalence of burnout and career satisfaction among oncologists in China: a national survey. Oncologist2019; 24(7): e480–e489.
42.
MarchalikDRodriguezANamathA, et al. The impact of non-medical reading on clinician burnout: a national survey of palliative care providers. Ann Palliat Med2019; 8(4): 428–435.
43.
Martins PereiraSTeixeiraCMRibeiroO, et al. Burnout in physicians and nurses: a multicentre quantitative study in palliative care units in Portugal. Revista de Enfermagem Referência2014; 4: 55–64.
44.
Montross-ThomasLPScheiberCMeierEA, et al. Personally meaningful rituals: a way to increase compassion and decrease burnout among hospice staff and volunteers. J Palliat Med2016; 19(10): 1043–1050.
45.
MoritaTTamuraKKusajimaE, et al. Nurse education program on meaninglessness in terminally ill cancer patients: a randomized controlled study of a novel two-day workshop. J Palliat Med2014; 17(12): 1298–1305.
46.
Orellana-RiosCLRadbruchLKernM, et al. Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an ‘on the job’ program. BMC Palliat Care2017; 17(1): 3.
47.
PattisonNDroneyJGruberP.Burnout: caring for critically ill and end-of-life patients with cancer. Nurs Crit Care2020; 25(2): 93–101.
48.
PelonSB.Compassion fatigue and compassion satisfaction in hospice social work. J Soc Work End Life Palliat Care2017; 13(2–3): 134–150.
49.
PereiraSMTeixeiraCMCarvalhoAS, et al. Compared to palliative care, working in intensive care more than doubles the chances of burnout: results from a nationwide comparative study. PLoS One2016; 11(9): e0162340.
50.
Popa-VeleaOTruŢEscuC-IDiaconescuLV, et al. The impact of Balint work on alexithymia, perceived stress, perceived social support and burnout among physicians working in palliative care: a longitudinal study. Intern J Occup Med Environ Health2019; 32: 53–63.
51.
SinghNWrightCKnightK, et al. Occupational burnout among radiation therapists in Australia: findings from a mixed methods study. Radiography2017; 23: 216–221.
52.
Slocum-GoriSHemsworthDChanWW, et al. Understanding compassion satisfaction, compassion fatigue and burnout: a survey of the hospice palliative care workforce. Palliative Med2013; 27(2): 172–178.
53.
WhitebirdRRAscheSEThompsonGL, et al. Stress, burnout, compassion fatigue, and mental health in hospice workers in Minnesota. J Palliat Med2013; 16: 1534–1539.
54.
YoonJDHuntNBRavellaKC, et al. Physician burnout and the calling to care for the dying: a national survey. Am J Hosp Palliat Med2017; 34: 931–937.
55.
LambdenJPChamberlinPKozlovE, et al. Association of perceived futile or potentially inappropriate care with burnout and thoughts of quitting among health-care providers. Am J Hosp Palliat Care2018; 36(3):1049909118792517.
56.
AlkemaKLJeremyMDaviesR.A study of the relationship between self-care, compassion satisfaction, compassion fatigue, and burnout among hospice professionals. J Soc Work End Life Palliat Care2008; 4: 101–119.
57.
BoernerKGleasonHJoppDS.Burnout after patient death: challenges for direct care workers. J Pain Symptom Manage2017; 54: 317–325.
58.
Davhana-MaseleseleMIgumborJO.The impact of caring for persons living with HIV and AIDS on the mental health of nurses in the Limpopo Province. Curationis2008; 31: 67–73.
59.
FreitasARCarnesecaECPaivaCE, et al. Impact of a physical activity program on the anxiety, depression, occupational stress and burnout syndrome of nursing professionals. Revista Latino-Americana de Enfermagem2014; 22: 332–336.
60.
FreyRBoydMFosterS, et al. Burnout matters: the impact on residential aged care staffs’ willingness to undertake formal palliative care training. Prog Palliat Care2014; 23: 68–74.
61.
GalianaLArenaFOliverA, et al. Compassion satisfaction, compassion fatigue, and burnout in Spain and Brazil: ProQOL validation and cross-cultural diagnosis. J Pain Symptom Manage2017; 53: 598–604.
62.
GamaGBarbosaFVieiraM.Personal determinants of nurses’ burnout in end of life care. Eur J Oncol Nurs2014; 18: 527–533.
63.
Gomez-CantornaCClementeMFariña-LopezE, et al. The effect of personality type on palliative care nursing staff stress levels. J Hosp Palliat Nurs2015; 17: 342–347.
64.
HayuniGHasson-OhayonIGoldzweigG, et al. Between empathy and grief: the mediating effect of compassion fatigue among oncologists. Psycho-Oncology2019; 28: 2344–2350. Professional Personnel Attitudes & Characteristics 3430.
65.
HeeterCLehtoRHAllbrittonM, et al. Effects of a technology-assisted meditation program on healthcare providers’ interoceptive awareness, compassion fatigue, and burnout. J Hosp Palliat Nurs2017; 19(4): 314–322.
66.
HunnibellLSReedPGQuinn-GriffinM, et al. Self-transcendence and burnout in hospice and oncology nurses. J Hosp Palliat Nurs2008; 10(3): 172–179.
67.
KalicińskaMChylińskaJWilczek-RóżyczkaE.Professional burnout and social support in the workplace among hospice nurses and midwives in Poland. Intern J Nurs Prac2012; 18(6): 595–603.
68.
KaurASharmaMChaturvediS.Professional quality of life among professional care providers at cancer palliative care centers in Bengaluru, India. Ind J Palliat Care2018; 24: 167–172.
69.
KleinCJRiggenbach-HaysJJSollenbergerLM, et al. Quality of life and compassion satisfaction in clinicians: a pilot intervention study for reducing compassion fatigue. Am J Hosp Palliat Med2018; 35: 882–888.
70.
MampuyaWAMatsuoYNakamuraAm, et al. Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG). J Rad Res2017; 58: 217–224.
71.
MeloCGOliverD.Can addressing death anxiety reduce health care workers’ burnout and improve patient care?J Palliat Care2011; 27: 287–295.
72.
Moreno-JimenezBRodriguez-CarvajalRHernandezEG, et al. Terminal versus non-terminal care in physician burnout: the role of decision-making processes and attitudes to death. Salud Mental2008; 31(2): 93–101.
73.
MoritaTMurataHKishiE, et al. Meaninglessness in terminally ill cancer patients: a randomized controlled study. J Pain Symptom Manage2009; 37: 649–658.
74.
O’MahonySZiadniMHoergerM, et al. Compassion fatigue among palliative care clinicians: findings on personality factors and years of service. Am J Hosp Palliat Care2018; 35: 343–347.
75.
OstacoliLCavalloMZuffranieriM, et al. Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices. Palliat Support Care2010; 8: 427–432.
76.
PavelkováHBužgováR.Burnout among healthcare workers in hospice care. Central Eur J Nurs Midwifery2015; 6: 218–223.
77.
PereiraSMFonsecaAMCarvalhoAS.Burnout in nurses working in Portuguese palliative care teams: a mixed methods study. Intern J Palliate Nurs2012; 18(8): 373–381.
78.
PodgurskiLGrecoCCroomA, et al. A brief mindfulness-based self-care curriculum for an interprofessional group of palliative care providers. J Palliat Med2019; 22(5): 561–565.
79.
PotashJSHoAHYChanF, et al. Can art therapy reduce death anxiety and burnout in end-of-life care workers? A quasi-experimental study. Int J Palliat Nurs2014; 20(5): 233–240.
80.
PuyatJHLeclercASongA, et al. Exposure to deaths and dying and risks of burnout among long-term care staff: a cross-sectional survey. Palliat Med2019; 33(6): 717–720.
81.
Quinn-LeeLOlson-McBrideLUnterbergerA.Burnout and death anxiety in hospice social workers. J Soc Work End Life Palliat Care2014; 10(3): 219–239.
82.
Rizo-BaezaMMendiola-InfanteSVSepehriA, et al. Burnout syndrome in nurses working in palliative care units: an analysis of associated factors. J Nurs Manage2018; 26(1): 19–25.
83.
SansoNGalianaLOliverA, et al. Palliative care professionals’ inner life: exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. J Pain Symptom Manage2015; 50(2): 200–207.
84.
TurnerJClavarinoAButowP, et al. Enhancing the capacity of oncology nurses to provide supportive care for parents with advanced cancer: evaluation of an educational intervention. Eur J Cancer2009; 45(10): 1798–1806.
85.
ValjeeLVan DykAC.Impact of caring for people living with HIV on the psychosocial well-being of palliative caregivers. Curationis2014; 37(1): 1201.
86.
KamalAHBullJHWolfSP, et al. Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. J Pain Symptom Manage2016; 51: 690–696.
RotensteinLSTorreMRamosMA, et al. Prevalence of burnout among physicians: a systematic review. JAMA2018; 320(11): 1131–1150.
89.
Canadas-De la FuenteGAGomez-UrquizaJLOrtega-CamposEM, et al. Prevalence of burnout syndrome in oncology nursing: A meta-analytic study. Psychooncology2018; 27(5): 1426–1433.
90.
Monsalve-ReyesCSSan Luis-CostasCGomez-UrquizaJL, et al. Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis. BMC Fam Pract2018; 19(1): 59.
91.
PortogheseIGallettaMLarkinP, et al. Compassion fatigue, watching patients suffering and emotional display rules among hospice professionals: a daily diary study. BMC Palliat Care2020; 19: 1–7.
92.
MüllerMPfisterDMarkettS, et al. How many patient deaths can a team cope with?: a nationwide survey of palliative care units in Germany. Schmerz2009; 23(6): 600–608.
93.
HillRCDempsterMDonnellyM, et al. Improving the wellbeing of staff who work in palliative care settings: a systematic review of psychosocial interventions. Palliat Med2016; 30(9): 825–833.
94.
PanagiotiMPanagopoulouEBowerP, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med2017; 177(2): 195–205.
EtkindSNBoneAEGomesB, et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med2017; 15(1): 102.
HarrisonKLDzengERitchieCS, et al. Addressing palliative care clinician burnout in organizations: a workforce necessity, an ethical imperative. J Pain Symptom Manage2017; 53(6): 1091–1096.
99.
GillmanLAdamsJKovacR, et al. Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review. JBI Database System Rev Implement Rep2015; 13(5): 131–204.
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